Stages of Dementia

LEVEL 1 – NORMAL AGING
LEVEL 2 – EARLY STAGE
LEVEL 3 – MIDDLE STAGE
LEVEL 4 – MIDDLE STAGE
LEVEL 5 – LATE STAGE
LEVEL 6 – LATE STAGE
LEVEL 7 – LATE STAGE
LEVEL 1 – NORMAL AGING

Level 1 - Normal Aging

CLINICAL CHARACTERISTICS

No cognitive changes evident. Normal aging, normal brain function.

LEVEL 2 – EARLY STAGE

Level 2 - Early Stage

Mild Cognitive Impairment (MCI)
Unknown timeline, possibly from age 40 to age 55/60
Minimal brain tissue loss

CLINICAL CHARACTERISTICS

Subjective cases of memory deficits 
Recovers relatively quickly from mistakes, may correct self 
Misplaces familiar objects 
Forgets names he/she knows well 
No problems completing tasks or at social functions 
Exhibits appropriate concern over memory function 
Vacillates between seeking medical care and ignoring symptoms 
Functions effectively at work 
Highly functional social skills 
Requires complete cognitive testing to determine challenges 
Anticipate cognitive medication administration 
Scores well on orientation test, requires cognition exam for diagnosis 
Amnesia beginning to be expressed

LEVEL 3 – MIDDLE STAGE

Level 3 - Middle Stage

Beginning Dementia
Stage may be 1 - 4 years or more
Minimal brain tissue loss

CLINICAL CHARACTERISTICS

Memory deficit evident on intensive interview 
Attempts to conceal deficits 
Expresses concern regarding deficits (mild/moderate anxiety) 
Problems performing in demanding situations (work or social) 
Co-workers/family members aware of increasing challenges 
Gets lost traveling to new areas 
Exhibits signs of cognition (reading) but retains little information 
Name/word finding difficulty more frequent 
Challenged to remember new names 
Denies any cognition difficulties 
Demonstrates high social skill level 
Uses humor to avoid answering questions 
No noticeable physical changes 
Beginning to skip steps in tasks 
Able to score well on orientation test, but not on cognition exam 
At times appears befuddled 
Amnesia, aphasia, agnosia present

 

 

LEVEL 4 – MIDDLE STAGE

Level 4 - Middle Stage

Moderate Dementia
Stage may be 1 - 4 years or more
4 ounces brain tissue loss
Equivalent to 12 year old to adulthood

CLINICAL CHARACTERISTICS

Decreased knowledge of current and recent events 
Memory deficits regarding personal history 
Decreased ability to perform serial subtractions 
Difficulty with immediate recall 
Difficulty with complex tasks 
Denial of deficits, with or with out agitation and annoyance 
Withdraws from challenging situations 
Increased anxiety/frustration over abilities or loss thereof 
Difficulty telling jokes, stories 
Decreased facial affect 
Increased appearance of depressive symptoms 
Begins incorrectly identifying family members 
Fluctuation in functioning can appear great at times 
May become lost in tasks 
Greater language challenges, word-finding 
Challenges in driving/operating car 
No weight loss or physical changes in appearance 
Begins keeping lists of family names, phone numbers, etc. 
Exhibits greater desire for sweet foods 
May score well on orientation test, deficits on cognition exam 
Amnesia, Aphasia, Agnosia and Apraxia present

LEVEL 5 – LATE STAGE

Level 5 - Late Stage

Moderately Severe Dementia 
All Dressed Up, Ready To Go 
Stage may be 1-3 Years 
½ to 1 pound brain tissue loss 
Equivalent to 8 – 12 year old 
*Equivalent to 4– 8 year old

CLINICAL CHARACTERISTICS

Disorientation to time (date, day of week, season, etc.) or place 
Immediate memory relatively intact 
Needs assistance choosing clothing, layers clothing 
May crave sweets over other foods 
Denies need for assistance with ADLs/IADLs 
Hunting and Gathering Stage 
Urinary Incontinence begins –monthly to weekly to daily 
Wears clothing appropriately (hearing aid, glasses, carries purse) 
Feeds self (may need meal set-up) 
Sleep disturbances 
Can score well on an orientation test 
Wanders looking for a way out (purposeful wandering/ Sun-downing) 
Follows simple instructions for ADLs, verbal cues needed for tasks 
Unexplained tearfulness or extreme laughter 
Catastrophic reactions 
Some resistance to care giving 
*May begin chronic Urinary Tract Infections 
*Appears severely depressed 
*Increased loss of facial affect 
*Coordinated movement/function beginning to be affected 
*Begins to be lost in current time 
*Difficulty recognizing self in a mirror 
*Challenged to recall family members 
*Accuses family members, caregivers of theft, infidelity, lying 
*Automatic “yes/no” speech functions, but without understanding 
*May begin using curse words as temporal lobes become damaged 
*Changes in visual perception increasing 
*Difficulty interpreting background noise 
*Challenged to perform rehab for injuries, may appear stubborn 
*Cannot give accurate information 
*Caregivers may confuse behavior for purposeful action – lying, etc. 
*Physical appearance beginning to be affected 
*Pilling or rubbing motions common, may enjoy folding items 
*Amnesia, Aphasia, Agnosia and Apraxia evident to outsiders

LEVEL 6 – LATE STAGE

Level 6 - Late Stage

Severe Dementia 
In My Own Little World 
Stage may be 1 - 3 Years 
1 to 1½ pounds of brain tissue loss 
Equivalent to 2 – 4 year old

CLINICAL CHARACTERISTICS

Unable to recall most recent events 
Repetitiveness in motion or speech or memory 
May be in constant motion, wanders/walks for hours 
Removes/won’t wear clothing appropriately (glasses, hearing aid) 
Refuses to change clothing 
Feeds self with set-up; cues; assist 
Bowel incontinence begins 
Sleep disturbances, may increase sleep, may require little sleep 
Catastrophic reactions, great resistance to care giving, bathing 
Purposeless wandering/Sun-downing (wandering without an agenda) 
Cannot complete a two-stage command 
Apraxia advanced, gait altered (small shuffling steps) 
Aphasia increased, great language loss 
Weight loss beginning 
Difficult to engage with caregiver, challenged to initiate conversation 
Disregards eyeglasses, dentures, hearing aids (agnosia) 
Disheveled appearance 
May begin sleeping for longer periods of time 
Difficult to perform rehab for injuries 
Almost total loss of facial affect 
May suddenly use complete sentence, then only words or sounds

LEVEL 7 – LATE STAGE

Level 7 - Late Stage

Very Severe Dementia 
Bedbound 
Total Care Required 
Stage may be 1 to 2 years 
1½ to 2 pounds brain tissue loss 
Equivalent to Infants – 2 year old

CLINICAL CHARACTERISTICS

Unable to recall most recent events 
Repetitiveness in motion or speech or memory 
May be in constant motion, wanders/walks for hours 
Removes/won’t wear clothing appropriately (glasses, hearing aid) 
Refuses to change clothing 
Feeds self with set-up; cues; assist 
Bowel incontinence begins 
Sleep disturbances, may increase sleep, may require little sleep 
Catastrophic reactions, great resistance to care giving, bathing 
Purposeless wandering/Sun-downing (wandering without an agenda) 
Cannot complete a two-stage command 
Apraxia advanced, gait altered (small shuffling steps) 
Aphasia increased, great language loss 
Weight loss beginning 
Difficult to engage with caregiver, challenged to initiate conversation 
Disregards eyeglasses, dentures, hearing aids (agnosia) 
Disheveled appearance 
May begin sleeping for longer periods of time 
Difficult to perform rehab for injuries 
Almost total loss of facial affect 
May suddenly use complete sentence, then only words or sounds 
Frequently no speech at all – mostly grunting 
Cannot feed self --- Chipmonking, high choking risk 
Unable to sit up independently, unable to hold head up 
Loss of basic psychomotor skills (unable to walk w/o assistance) 
Hyper oral (may put everything in mouth) 
Requires total care, Displays great muscular flexation 
Extreme risk for skin breakdown 
Spends majority of day asleep or semi-alert 
Loss of ability to smile – indicative death is near

utangling_dementia

Book Price: $20.00

(shipping included)

Untangling Alzheimer's

Taking the fear and mystery out of Alzheimer's Disease, Lewy Body Dementia, Frontotemporal Dementia, Vascular Dementia, Parkinson's, Huntington Disease or other forms of dementia, this bestselling book makes a complex and often overwhelming disease process understandable to all readers. Whether you are a first time family caregiver or a professional care partner, Untangling Dementia will change your life.

Readers will:

Discover what a dementia diagnosis means for a family

Learn about the seven stages of dementia

Understand how damage in the brain causes behavior changes

Recognize signs associated with the A’s of dementia

Improve their ability to communicate with and care for loved ones

Track the stages of dementia utilizing Tam's DBAT (PDF), a free downloadable tool.

Large Book Orders

Please contact us for special pricing before ordering.

Non Profit Organizations

Please contact us for special pricing before ordering.

Dr. Tam's autograph signature is available upon request.

Reviews

"Untangling Dementia is a winner. Complex ideas are presented in a way that caregivers can apply them to their loved ones on a daily basis. It is a book I wholeheartedly recommend.”
DENNIS R. MYERS Ph.D., LCSW, Kronzer Professor in Family Studies, Baylor University

“This book will be given to every family who visits our community and be required reading for all my employees. Tam does a marvelous job walking the reader through dementia – from diagnosis to death – in a caring, loving way.”
CARLA COCHRAN, RN, Owner,Clonial Gardens Memory Care Communities of Texas — www.cgtexas.com

“Tam has a true gift when it comes to helping others understand Alzheimer’s and dementia. The information she provides in this book is invaluable for anyone who provides care for a loved one.”
MARY NORRIS, Family Caregiver, Alexandria, Virginia

"Untangling Dementia" is absolutely the most enlightening thing I have read since facing Frontaltemporal Dementia. It has answered so many questions you would not believe. My whole attitude has changed as a result of this book and the beautifully laid out stages of dementia. This woman knows her stuff!"
G.L. Hamnet

"This book is the best! I am mailing them out to family members along with your chart so my husband's children and siblings can read it and understand where he is. Your book and chart made me realize that he is much further along than I thought - he just still has good social skills and compensates well. Thank you for your wonderful work!"
B. A. Hanson

"Thank you so much! I have ordered five copies for my family and the caregiver. I'll have a copy for those who care for my husband so they might better understand the disease. Very few Home Care Agencies educate the caregivers so I find it's my "job" to try to do that and having your book is a great help."
A. Tholsen

"Just wanted to let you know that we gave your book to a new resident's family. Two of the children were "on the same page," but unfortunately the son was not. At our support group this week the daughter told me that her brother had read your book and called her on the phone to tell her that he had an epiphany after reading your newest book and he now "gets it," as they say... Thank GOODNESS, and THANKS, TAM!!!"
N. Thurenco

"This book presents the reader with a very honest and candid look at Alzheimer's Disease and its progression. Ms. Cummings' experience has obviously allowed her to develop a "compassionate directness" that is hard to come by. While one must understand what to expect in a loved one as he or she progresses through the stages of the disease process, Ms. Cummings also presents the reader with valuable insight into what all people involved may experience as well. And she does so with the voice of a teacher, of wisdom of a trained Gerontologist, and the heart of an experienced care-giver. Thanks for writing this book. The language you use and the stories you tell fill a much-needed niche in the Alzheimer's literature."
Dr. Melody Madlem

"I have been dealing with my mother's rapidly advancing dementia for a couple of years and was given this book by the memory care facility where she now lives. I wish I had this book a couple of years ago. It provides a VERY helpful road map for the different stages of dementia. I was going along fairly blindly from one stage to the next, wondering what was happening. Once I read the book I realized she had been progressing through the stages described in the book. I now feel better prepared to cope with the next stages. While it is not easy to read about what is to come, at least I can prepare myself and better help my mother. If you have a family member or friend suffering from dementia this is a must read book!"
Rick Mayo

"This book is fabulous! It is such a great guide for anyone struggling with dementia, whether it is in their family or if they are working in an industry where they care for people with this disease. I am a marketing director for a memory care community, and I find that so many families I encounter have such a hard time understanding dementia. They are usually stressed out and overwhelmed from caring for their family member who is suffering with this terrible disease. There is not enough time in my office to give them all the help and education that I would like to, so I have started using Tam's book as a resource. This book has been a blessing! I ordered my first box and have been giving them out to every family that comes into my office. I have had the most wonderful feedback from everyone! Thanks Tam for sharing your knowledge and experience! It is immeasurable to all of us!"
Blitz' Mom

"My husband suffers from Alzheimer's. I have purchased this book for our children, grandchildren, and caregivers. It is an essential read if you are dealing with this cruel disease. It is easy to read and the Points to Remember at the close of each chapter really help. The book includes information about other forms of dementia too. You may think you understand Alzheimer's and other dementias, but I am certain you will learn more about the diseases, how to cope with them, and how to specifically care for those with the diseases by reading this book. The author will tell you that if the reading becomes too difficult - put the book down & return to it later. She understands how emotional reading such truths can be. I highly recommend this book."
Ann

"One of the wonderful things about this book is Cummings’s gifted way of using true-to-life examples that illustrate her points and make them easier to understand. Her explanations are matter-of-fact, but they are not without compassion for the experience. Her book contains nuggets of wisdom that every family who has someone with dementia should hear. If you are someone or know someone who has received a diagnosis of dementia and would like a great read that will give you some understanding, support, and implementable takeaways in facing your new journey, Untangling Dementia is a wonderful place to start. Thank you, Tam, for this great resource. "
J. Penney

"Hello Tam, I’m M.L., from Corpus Christi. I attended this year, for the first time, the Face to Face Caregivers Workshop. My intention was to go and listen to your presentation and I’m glad I did. You were fantastic! While listening to you, I kept on thinking of so many friends that should have been there to listen to what you had to say. So, thank you for your presentation!!"

"Now, about your book… oh my gosh, it’s a must have book for any Caregiver! I only bought two books, I could have bought a couple more, to give to friends. I will visit your website and buy them. The book is so well written. I found your book easy to read, very real… (really, thanks for not hiding anything from us J!) and practical. This book is now my “security blanket” always close by, to help me with any down moments I may be having."
M.L.